Deeply interesting article by Michael Guy Thompson, from his own experiences. Many of us here have an interest in Laing’s work, which has huge resonance with what we are seeking to offer to our clients as a person-centred service, as an alternative to medical model/psychiatric ways of seeing and doing.

Laing was a pioneer. As Michael puts it, Laing and his co-workers’ residential houses offered ‘“asylum” from forms of treatment — psychiatric or otherwise’ that they saw to be unhelpful and even as adding to the difficulties of those subjected to them.

Laing favoured a ‘hands-off’ approach that relied on relationship and simple human connection in place of drugs. Time and again, he demonstrated the power of this – most famously with people with diagnoses of schizophrenia.

I’m interested in Laing/his fellow therapists’ ease with the topical hot potato of ‘dual and multiple relationship’. As Michael puts it, describing the arduous process for admission to one of the houses:-

‘To complicate matters further, every applicant had to be admitted unanimously. One negative vote and you were rejected. Yet, once in, the new member could count on the unadulterated support of everyone living there, because of the fact that everyone supported his moving in. The sense of community and fellow-feeling was extraordinary. So was the frankness with which everyone exercised their “candid” opinions about everyone else. The effect could be startling, as one was slowly stripped of the ego that was so carefully created for society’s approval. I soon realized why candor is something most of us prefer to avoid, however much we complain about its absence. Again, the similarity to the psychotherapy experience was unmistakable. But now, instead of having to contend with merely one therapist for one hour a day, at Portland Road you were confronted with an entire cadre of relationships, all of whom engendered transference reactions, all of which you had to manage and work through.’

So the full on complexity of human relationship, as we experience it in the real world, with few rules or fixed ‘boundaries’, and – in their stead – a therapeutic container of congruence, empathy and a deep underlying valuing of and commitment to each person involved, whether ‘therapist’ or ‘client’. This is, of course, a profoundly demanding model for all concerned. Yet its potential for depth of relationship and for connection (and therefore healing) vastly exceeds that of more arms-length, ‘doing to’ models, where the therapist stays safely behind a screen of ‘professional boundaries’ and the client knows it.

Jerome’s story is a beautiful illustration, both of how Laing and his colleagues worked experientially and of how people were drawn to this, often when all other options had failed them and the picture looked bleak:-

‘The psychiatrist who contacted Laing confessed that his colleagues at the hospital had thrown in the towel with Jerome and vowed that if he were admitted to the hospital again he wouldn’t leave. This, now, was the fourth such episode. On this occasion, when his parents implored Jerome to come out of his room he replied that he would on one condition: that Laing would see him. Jerome had read The Divided Self and concluded that Laing was the only psychiatrist he could trust not to “treat” him for a mental illness.’

I love those last words: ‘Jerome had read The Divided Self and concluded that Laing was the only psychiatrist he could trust not to “treat” him for a mental illness.’

Jerome’s story illustrates the respect for and deference to the ‘client’s’ frame of reference that lay at the heart of Laing’s approach – even when there was no obvious rhyme or reason and when it caused substantial challenges for everyone concerned:-

‘When Jerome visited Portland Road, he recounted what he wanted. He wanted a room of his own, to stay in until he was ready to come out. We were asked to honor his request and, with some trepidation, we agreed to his terms. I single Jerome out, of all the other people I came to know at Portland Road, because he presented us with the most serious challenge we had ever had to face. Due to the nature of his terms, Jerome effectively deprived Portland Road of its most effective source of healing: the communion shared by the people living there. Jerome’s plan undermined the philosophy that Laing and Hugh Crawford had formulated, a sense of fellow-feeling that honored a fidelity to interpersonal experience, no matter how crazy or alarming a person’s participation in that process was. We felt that Jerome was entitled to pursue the experience he felt called upon to give way to, even if the outward behavior his experience effected was problematic. Though a person’s experience is a private affair, the behavior with which one engages others is not. Because the two are invariably related, the philosophy at Portland Road was to tolerate unconventional behavior to an amazing degree in order to facilitate the underlying struggle that person was engaged in.’

I think this is KEY to effective therapy – the therapist’s commitment to client autonomy, and ability to tolerate difference, discomfort, risk and uncertainty, in the service of another’s process, struggle and journey, in order to provide effective therapeutic relationship and the deep healing this can bring. This can be extraordinarily hard and demanding, as Jerome’s story shows. That is why, in my view, teaching therapists theory is an interesting side-alley of therapy training. The element that matters, is supporting the trainee therapist in becoming a deeper, fuller, more realized self – because it is only those of us who have engaged enough and effectively enough with our own ‘underlying struggle’ who can truly offer effective therapeutic support at depth to those losing themselves in the dark of their own struggles. There are, I fear, many therapists who have themselves not made this journey at depth, who purport to be able to accompany others – and actually offer an arms-length ‘professional’ relationship (with inbuilt and entrenched power differential) that has far more limited healing potential.

‘The conventional psychoanalytic setting, for example, places enormous constraints on a person’s behavior, including the use of a couch to facilitate candor. At Portland Road, you were obliged to live with the behavior that everyone else exhibited, so the course of a given person’s behavior was unpredictable, and sometimes violent. In other words, there was an element of risk in living in such conditions because no one knew what anyone else was capable of and what lengths some might go to in order to be “true” to what they were experiencing, authentically.’

Jerome’s story illustrates the level of discomfort and uncertainty – and need for sheer dogged patience and willingness to hang in there – required. No medical tidying away, antiseptic environment or order here – mess and smell and complication and fear:-

‘The stench of his incontinence became onerous, though Jerome was apparently oblivious to it. Not surprisingly, he soon became the topic of conversation each evening around the dinner table.

“What are we going to do about him,” we wondered. Ironically, he had transformed Portland Road into a mental hospital. We were constantly concerned about his physical health, his diet, and the increasing potential for bed sores, which he eventually developed. He continued to lose weight due to the meager amount of food he was eating. We could either tell him he had to leave or we had to capitulate to the extraordinary conditions he presented us with. As news of our dilemma leaked out, Laing became increasingly nervous.’

I am struck by the elements of what I want to describe as boredom, even dislike, sitting alongside the evident commitment to Jerome (over many months). Also by the conflict between the therapists involved, the differences of opinion, the ‘fumbling in the dark’ quality of this work:-

‘We were ready, – eager! – to admit defeat and resign ourselves to an unmitigated failure. Jerome’s condition was apparently interminable. His “asylum” with us had become for him simply a way of life. It seemed obvious to us now that this was all he had really wanted from us, to live in the squalor he had generated around himself.’

And yet they did not ‘admit defeat’. They continued to hang in there through it all (in my view, perhaps the single greatest gift any therapist can offer any client, or any one human being can offer another – because we are way beyond the purely psychotherapeutic arena here). Still more significantly, Michael describes a gradual, almost accidental, acceptance of Jerome and his cussed, uncomfortable engagement in his struggle, his unique and self-determined journey:-

‘The time, in the immortal words of Raymond Chandler, staggered by and the urgency of Jerome’s situation gradually became a commonplace, and somehow less urgent to resolve. Life continued at Portland Road independent of Jerome’s situation. Others had their problems too, which were addressed in the communal way that was our custom. Another month slipped by, and then another, until I finally lost track of the time and stopped counting.’

In other words, they stopped trying to fix it.

And:-

‘..we hardly noticed that evening by the fire when Jerome nonchalantly sauntered downstairs to use the bathroom. When he was finished he flushed the toilet, peeked his head into the den to say hello, and quietly returned upstairs. To put it mildly, we were in a state of shock, and pinching ourselves to make sure we weren’t dreaming.’

Michael continues:-

‘Nearly forty years later, Jerome has never experienced another psychotic episode again. He soon left Portland Road, resumed his life, and proved to be an unremarkable person, really; ordinary in the extreme.’

As he identifies, this account raises all kinds of questions about the nature of therapy, about how we can know what will ‘work’ or what did ‘work’. Did Jerome shift ‘because of’ or ‘in spite of’? What would have happened had he remained within the psychiatric system, against his will (as would almost certainly have been his fate in Laing’s absence)? We cannot know and ultimately there is here an element of unresolved mystery, as in all the deeper existential questions.

Michael comments with undoubted accuracy (and perhaps even more relevantly today than it was in the early 70s):-

‘The way that we struggled with and responded to Jerome’s impasse as it unfolded will no doubt be regarded as reckless, indulgent, dangerous, even bizarre by the psychiatric staff of virtually every mental hospital in the world. His behavior — intransigent, stubborn, resistant — would no doubt be met with an even greater force of will, determination, and power than his own. Who do you suppose, given the forces at play, would ultimately “win” such a contest? Naturally, the use of medicating drugs would be brought to bear, and electric shock, as well as whatever form of incarceration is deemed necessary.’

Then he makes the – to my mind, based on all my therapeutic experience in the past decade – critical point:-

‘But what manner of treatment can a person wholeheartedly submit to when it coerces its way in, without invitation or compassion? And let’s be frank about this, without love. It seems to me, on reflection, that it was our love for Jerome that finally had its way when we backed off from all of our efforts to “help” him, when we were able to just let him be, as he had asked us to, and allow him to join our community, but on his terms, not ours.’

It’s love that works in therapy. Nothing else. And what that looks like in practice is manifest in this account of the Portland Road house and Jerome’s story. Love is never about deciding for the other person. We have to be allowed to decide for ourselves, in order to heal and grow. For the therapist, that means acquiring the very considerable grounding in self, and ability to connect with self/other at loving empathic depth, needed to step outside the medical model preference for arm’s length ‘safety’, into the risk, complications and messiness of real human relationship.

Michael concludes:-

‘Laing saw his role as one of helping the people who came to see him “untie” the knots they had inadvertently tied themselves in. He believed this entailed extraordinary care to not repeat the same types of subterfuge and coercion that had got them into those knots in the first place. Jerome had tied himself in a knot, and had come up with his own solution as to what he needed to do in order to untie them, including his insistence on doing this silently. That we were able to get out of his way and facilitate his task was nothing short of a miracle.

This degree of non-intrusion in the context of psychotherapy is a rarity. Those therapists who believe it is incumbent on them to run a “tight ship,” who maintain their authority over their patients at all costs, and who reduce the therapy experience to a set of techniques that can be learned aren’t likely to embrace a method of “treatment” that is as modest in its claims as it is cautious with its interventions. Jerome taught me that techniques are of no use when all a person is asking is to be accepted for who he is, unconditionally.’